Wound Dressings – a Review

DOI 10.7603/s40681-015-0022-9 BioMedicine (ISSN 2211-8039) December 2015, Vol. 5, No. 4, Article 4, Pages 24-28 Review article Wound dressings – a review Selvaraj Dhivyaa,b, Viswanadha Vijaya Padmab, Elango Santhinia,* aCentre of Excellence for Medical Textiles, The South India Textile Research Association, Coimbatore 641 014, Tamil Nadu, India bDepartment of Biotechnology, Bharathiar University, Coimbatore 641 044, Tamil Nadu, India Received 3rd of September 2015 Accepted 29th of October 2015 © Author(s) 2015. This article is published with open access by China Medical University Keywords: ABSTRACT Wound healing; Traditional dressings; Wound healing is a dynamic and complex process which requires suitable environment to promote healing Modern dressings process. With the advancement in technology, more than 3000 products have been developed to treat different types of wounds by targeting various aspects of healing process. The present review traces the history of dressings from its earliest inception to the current status and also discusses the advantage and limitations of the dressing materials. 1. Introduction 2. Factors affecting wound healing process A wound is defined as a disruption in the continuity of the epithe- Wound healing is the result of interactions among cytokines, lial lining of the skin or mucosa resulting from physical or thermal growth factors, blood and the extracellular matrix. The cytokines damage. According to the duration and nature of healing process, promote healing by various pathways such as stimulating the the wound is categorized as acute and chronic [1, 2]. An acute production of components of the basement membrane, preventing wound is an injury to the skin that occurs suddenly due to acci- dehydration, increasing inflammation and the formation of granu- dent or surgical injury. It heals at a predictable and expected time lation tissue. These pathways are affected by various local and frame usually within 8-12 weeks depending on the size, depth and systemic factors [16]. Local factors which includes hypothermia, the extent of damage in the epidermis and dermis layer of the skin pain, infection, radiation and tissue oxygen tension directly influ- [3, 4]. Chronic wounds on the other hand fail to progress through ence the characteristics of the wound where as systemic factors the normal stages of healing and cannot be repaired in an orderly are the overall health or disease state of the individual that affect and timely manner [5, 6]. Chronic wounds generally results from individual’s ability to heal [17]. In addition to these factors, poor decubitis ulcer, leg ulcer and burns. Wound healing is a dynamic nutrition, age and protein, vitamins and mineral deficiency can and complex process of tissue regeneration and growth progress also prolongs healing times. through four different phases (i) the coagulation and haemostasis phase (immediately after injury); (ii) the inflammatory phase, 2.1. Syndromes associated with abnormal healing (shortly after injury to tissue) during which swelling takes place; (iii) the proliferation period, where new tissues and blood vessels Ehlers-Danlos syndrome (EDS) is a genetic connective tissue are formed and (iv) the maturation phase, in which remodeling of disorder characterized by defects of the major structural protein new tissues takes place [7-12]. These phases occur in an ordered Collagen. Autosomal dominant and autosomal recessive forms manner overlapping with each other in a well-connected cascade of EDS equally affect males and females. Since the collagen is a [13, 14]. Promotion of these phases are largely depends on the major structural protein and provide elasticity to body cells and wound type [15], and its associated pathological conditions and tissues, its damage results in articular hyper mobility leading to the type of dressing material. With the advancement in technol- partial or complete dislocation of joints and elastic skin. Based ogy, currently, different types of wound dressing materials are on the defects and inheritance mode, EDS is categorized into six available for all types of wounds. But the selection of a material major subtypes and they are distinct in affecting individuals [18]. for a particular wound is important to achieve faster healing. In Cutis Laxa is characterized by (Lysyl oxidase) enzyme de- this review, an attempt has been made to consolidate the different ficiency resulting in abnormality of copper metabolism leads to types of wound dressing materials and their function on healing abnormal loose skin, muscular organ and skeletal abnormality. process. Wrinkled skin, particularly on the neck and mild mental retarda- * Corresponding author. Senior Scientific Officer, Centre of Excellence for Medical Textiles, The South India Textile Research Association, Coimbatore 641 014, Tamil Nadu, India. E-mail addresses: [email protected], [email protected] (E. Santhini). BioMedicine | http://biomedicine.cmu.edu.tw/ 24 December 2015 | Volume 5 | Issue 4 | e49 tion also characterized by this disorder. X-linked cutis laxa also (e.g. polyurethane foams, hydrocolloids, iodine-containing gels). called as (OHS) occipital horn syndrome, a rare disorder that During the mid 1990’s, synthetic wound dressings expanded into was formely classified as a subtype of EDS. Cutis laxa is further various group of products which includes hydrogels, hydrocol- classified into four genetic forms based on their pattern of inheri- loids, alginates, synthetic foam dressing, silicone meshes, tissue tance. These includes sex-linked defective on X chromosome, adhesives, vapor-permeable adhesive films and silver/collagen autosomal dominant defective on autosomal chromosome and two containing dressing. types of autosomal recessive inheritance defective on chromosome 5 Among these types, autosomal recessive forms are more 4.1. Traditional wound dressing severe than other forms [19]. Traditional wound dressing products including gauze, lint, plasters, bandages (natural or synthetic) and cotton wool are dry and 3. Characteristics of an ideal wound dressing used as primary or secondary dressings for protecting the wound from contaminations [30]. Gauze dressings made out of woven Based on the wound type, suitable dressing material must be used. and non woven fibres of cotton, rayon, polyesters afford some Dressing selection should be based on its ability to a) provide or sort of protection against bacterial infection. Some sterile gauze maintain moist environment b) enhance epidermal migration c) pads are used for absorbing exudates and fluid in an open wound promote angiogenesis and connective tissue synthesis d) allow with the help of fibres in these dressings. These dressings require gas exchange between wounded tissue and environment e) main- frequent changing to protect from maceration of healthy tissues. tain appropriate tissue temperature to improve the blood flow to Gauze dressings are less cost effective. Due to excessive wound the wound bed and enhances epidermal migration f) provide pro- drainage, dressings become moistened and tend to become adher- tection against bacterial infection and g) should be non-adherent ent to the wound making it painful when removing. Bandages to the wound and easy to remove after healing h) must provide made out of natural cotton wool and cellulose or synthetic ban- debridement action to enhance leucocytes migration and support dages made out of polyamide materials perform different func- the accumulation of enzyme and i) must be sterile, non-toxic and tions. For instance, cotton bandages are used for retention of light non-allergic. dressings, high compression bandages and short stretch compression bandages provide sustained compression in case of venous ulcers. Xeroform™ (non-occlusive dressing) is petrolatum gauze 4. Wound Dressings with 3% of Bismuth tribromophenate used for non-exudating to slight exudating wounds. Tulle dressings such as Bactigras, Jelonet, Wound, whether it is a minor cut or a major incision, it is important Paratulle are some examples of tulle dressings commercially to care for it properly, part of this process includes wound dressing. available as impregnated dressings with paraffin and suitable Dressing is designed to be in contact with the wound, which is for superficial clean wound. Generally traditional dressings are different from a bandage that holds the dressing in place. Histori- indicated for the clean and dry wounds with mild exudate levels cally, wet-to-dry dressings have been used extensively for wounds or used as secondary dressings. Since traditional dressings fail to requiring debridement. In 1600 BC, Linen strips soaked in oil or provide moist environment to the wound they have been replaced grease covered with plasters was used to occlude wounds. Clay by modern dressings with more advanced formulations [30]. tablets were used for the treatment of wounds by Mesopotamian origin from about 2500 BCE. They cleaned wounds with water 4.2. Modern wound dressing or milk prior to dressing with honey or resin. Wine or vinegar usage for cleaning the wounds with honey, oil and wine as further Modern wound dressing have been developed to facilitate the treatment was followed by Hippocrates of ancient Greece in 460- function of the wound rather than just to cover it. These dressings 370 BCE. They used wool boiled in water or wine as a bandage are focused to keep the wound from dehydration and promote [20]. There was a major breakthrough in the antiseptic technique healing. Based on the

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